Is it ok if I vary the 28 day cycle on cyclical prog?

[HairyKitty]

I was having fairly regular periods but they varied from say 26 to 35 days in length.
So is there any problem if I start the 12 days of progesterone on the 15th day of a months actual cycle (providing it’s not more than 35 days long), rather than forcing a 28 day cycle which I think has more chance of causing breakthrough bleeding?
does that make sense??

HRT resets the cycle so there is no need to try to align it with your own.
My consultant suggests choosing a date each month, such as the 1st or the 15th (whatever is easy to remember) and keeping to it, regardless of what your cycle was before HRT.

That means you will take it for 12 days each calendar month, which is 30-31 days. (So it's not 28 days anyway.)

You could do partly what you suggest which is start it mid-cycle on your next cycle (bleed is Day 1) but keep to that same date. So if mid cycle happened to be 30 July, start again 30 August.

You shouldn't get breakthrough bleeding as once you are taking the Utrogestan it usually stops that.

Doing it 'your way' would eventually become impossible, as you may have cycles that are 18 days long or 80 days, when they become very irregular, and you won't know in advance which.

I’ve already been taking progesterone for a few months but the withdrawal bleed is varying from 2-4 days after stopping progesterone. Meaning that if I stick to the 28 day cycle I will
be starting progesterone some months almost as soon as the withdrawal bleed finishes. Which would be the case in a natural cycle

Are you saying that starting on the same day each month isn't what you want to do?

Out of a 30-31 day month, you take Utrogestan for 12 days, regardless of when you bleed after it.

So for example, someone could take 12 days from 1 August - 12 August.
The bleed might start on the 15th/ 16th August (and last for anything from 2-5 days.)

Then you would start the next 12 days of Utrogestan on the 1st September.

There will be the days from 12th August to the 1st September without any Utrogestan (that's 17/ 18 days.)

Have I misunderstood what you are asking?

Hmm yes starting on same day isn’t what I want to do. I’m saying I want to be able to slightly vary the cycle so it’s 12 days in day say every 28-35 days (when the withdrawal bleed is later) as I think I will be less likely to have breakthrough bleeding then.

I have a 25 day cycle and on the advice of the doctor have started my progesterone on day 14 to give me a 28 day cycle. I’m intrigued about whether or not it’s going to work and won’t know your until I finish this cycle. That was the advice given to me though.

Have you had breakthrough bleeding since you started using it?

The HRT usually resets your cycle and overrides it.

Women who use tablet form HRT can't have any variation at all, when they start the progestin, regardless of their cycle length.

It's normal for the withdrawal bleed to vary a bit, by a day or two, simply because micronised progesterone is variable in how much your body absorbs. (It's a bit more predictable using it vaginally.)

On HRT you have to forget about your own cycle and create a new one. It doesn't work trying to follow your own because eventually your cycles will be so erratic (very close together or very far apart) that it would be impossible.

I think I was presuming that since my previous cycle was a full usual regular cycle, there’s the possibility of breakthrough bleeding since the hrt doesn’t inhibit the production of your own hormones?

Your cycles aren't really regular though as they can be 10 days difference almost ( 26-35 days.)

When you are on HRT, the only bleed you should get is when you stop the progesterone.

Your own cycle doesn't override the HRT - not sure why you thought that?

What you are trying to achieve is impossible because eventually your periods will be all over the place and you simply won't be able to keep shifting the progesterone to when you think it will coincide with your cycle.

I read up on this, you need to have the progesterone cycle every 3 months.

“Your own cycle doesn't override the HRT - not sure why you thought that?”

Isnt that exactly what breakthrough bleeding is. When your own hormones are contributing to bleeds which don’t align with the artificial Horne timings? HRT doesn’t neutralise your own hormones, they are still there going up and down in the background right? Isn’t the HRT just usually masking there effects, sometimes better than others?

Honestly, you just need to choose a date and stick with it. You’re over complicating things by trying to manipulate your cycle. So start progesterone on 1st, 15th, 30th whatever, take for 12 days and repeat the same date the following calendar month. This will give you a ‘regular’ cycle, with a predictable withdrawal bleed each month.

Well the withdrawal bleed isn’t proving to be as predictable as I expected is the thing, and I’m concerned that continuing on fixed days will therefore result in breakthrough bleeding. Is this not the case then?

I've said the same thing many times! 😀

I'm not sure what you are expecting when you say it's not 'predictable'.

I don't know think anyone has a completely 100% predictable bleed on Utrogestan. Mine is usually on day 3 or day 4 after the last capsule. At times it's come early, sometimes before the last capsule, but much less so since using it vaginally. This is usually nothing to do with your own cycle - it's because the serum levels of utrogestan can vary more than other types of progestin.

Did you understand what I said about women who use HRT in tablet form? They don't try taking it at different times of the month - they just take the tablets in the pack.

why is it so important to not have a bleed a day or two early?

The only definitive way to know is to test it. Commit to starting progesterone on the same date each calendar month for the next three months. The withdrawal bleed might come after 2 days or 4 days but personally I wouldn’t focus on that aspect. See how you go for the three months. That’s my advice anyway 🤷‍♀️

@HairyKitty

Breakthrough bleeding can occur with sequential HRT if the natural estrogen plus the HRT estrogen are not controlled by the dose of progesterone.

It's not so much about cycle length (which is what you seem to be saying) but about the amount of progesterone reaching the womb. If it's enough, the lining doesn't shed until progesterone is withdrawn, after 12 days.

Many women in peri have anovular cycles, (no ovulation) so the lining builds up in the first half of the cycle, but there is no ovulation and therefore no progesterone is produced (which would control the growth of the lining) and no period. Then when there is one, it's heavy.

HRT is supposed to regulate this by providing the progesterone that may be missing in some cycles in peri.

If you have breakthrough bleeding on HRT the medical advice is to try either another form of progestin (synthetic types that are stronger) or to increase the dose and length of micronised progesterone (ie 14 days not 12.)

I've used Utrogestan for many years and the bleeds can be a day or more 'out'. Taking the capsules with food actually doubles the concentration in the blood levels, so that's worth thinking about if you find you are bleeding early on it.

Thank you this is all helpful.
I don’t care whether the bleed is a day or two early.
What I’m trying to work out is if your own progesterone cycle gets out of sync with the hrt, does this cause breakthrough bleeding (which I don’t want).
I think we are saying that it doesn’t?